Detection of HIV-related proteins in urine

ABSTRACT

A method for detecting HIV infection in a mammal is disclosed. The method contains the steps of isolating exosomes from a urine sample of a mammal and detecting the presence of HIV-specific biomarker in said isolated exosomes. A method for diagnosing a mammal with an HIV-associated disease, in particular, HIV-associated nephropathy is also disclosed.

This application is a continuation application of U.S. patentapplication Ser. No. 12/572,652, filed Oct. 2, 2009, which claimspriority from U.S. Provisional Application Ser. No. 61/102,941, filedOct. 6, 2008. The entirety of all of the aforementioned applications isincorporated herein by reference.

FIELD

The present invention generally relates to methods for diagnosis and, inparticular, to methods for detecting HIV infection, diagnosing HIV orHIV-associated diseases using biomarkers in the urine.

BACKGROUND

HIV tests are generally performed on serum or plasma. The detection of aHIV antibody is presumptive evidence of HIV-1 infection, and istypically confirmed by the Western blot procedure. Detection of virus byp24 antigen determination or detection of viral RNA by RT-PCR is alsoused to determine the amount of virus in circulation. CD4/CD8 T cellratios and other immune function tests are often used to monitor immunestatus and progression to AIDS. More recently, HIV tests using saliva orepithelia cells in the mouth have also been developed. However,currently there is no test available to measure antigen or antibody inurine. The detection of HIV proteins in the urine may provide a morerapid method to detect HIV infection or progression of disease,particularly renal complications.

HIV-Associated Nephropathy (HIVAN), a renal disease thatdisproportionately afflicts people of African descent, is characterizedby kidney hypertrophy and rapid progression and stage renal disease.HIVAN is caused by direct infection of the renal cells with the HIV-1virus and leads to renal damage through the viral gene products. Itcould also be caused by changes in the release of cytokines during HIVinfection. The etiology of HIVAN is still unknown. It is estimated that90% of HIVAN sufferers are people of African descent, suggesting agenetic predisposition to the disease (Wyatt, C. M., Klotman, P. E.HIV-Associated Nephropathy. in the Era of Antiretroviral Therapy.American Journal of Medicine Review 2007).

Renal biopsies of patients showing focal segmental glomerulosclerosiswith tubular dilation and inflammation, microcystic tubules,degenerating glomerular capillaries in conjunction with markedproteinuria is diagnostic for HIVAN (supra). This method, however, is aninvasive procedure and is sometimes rejected by patients because of itsinvasiveness. Therefore, there exists a need for diagnostic test fromHIV or an HIV associated disease that is reliable, rapid, cost-effectiveand less invasive.

SUMMARY

One aspect of the present invention relates to a method for detectingHIV infection in a mammal. In one embodiment, the method contains thesteps of isolating exosomes from a urine sample of said mammal anddetecting a HIV-associated biomarker from said isolated exosomes.

In a related embodiment, the method further comprises the step ofdetermining whether the mammal is infected by HIV based on the presenceor absence of HIV-associated biomarkers in the isolated exosomes.

In a related embodiment, the exosomes are isolated by centrifugation.

In another related embodiment, the exosomes are isolated by filtration.

In another related embodiment, the exosomes are detected by one or moretechniques selected from the group consisting of: electrophoresis,Western blot, HPLC, FPLC, MS and protein sequencing.

In another related embodiment, the exosomes are detected by SELDI-TOF-MSand LC-MS/MS.

In another related embodiment, the HIV-associated biomarker is selectedfrom the group consisting of Nef, HIV envelope gp120, HIV protease, Vif,Gag-Pol, Gag, p24, Rev, reverse transcriptase (RT), Tat, p1, p17, Vpu,Vpr, gp41 and DNA polymerase.

In another related embodiment, the HIV-associated biomarker is Nef, HIVprotease, Vif, Pol or Gag.

In another related embodiment, the HIV-associated biomarker is Nef.

In one related embodiment, the mammal is a human, monkey, gorilla orbaboon.

In another related embodiment, the mammal is a human.

Another aspect of the present invention relates to a method fordiagnosing HIV-associated disease in a mammal. In one embodiment, themethod contains the steps of isolating exosomes from a urine sample ofsaid mammal and detecting a HIV-associated biomarker from said isolatedexosomes.

In other related embodiment, said HIV-associated disease isHIV-associated nephropathy.

In another related embodiment, the method further comprises the step ofdetermining whether the mammal is suffering from HIV-associatednephropathy based on the presence or absence of said HIV-associatedbiomarker in the isolated exosomes.

In one related embodiment, the mammal is a human, monkey, gorilla orbaboon.

In another related embodiment, the mammal is a human.

Another aspect of the present invention relates to a method formonitoring the progress of HIV infection in a mammal. In one embodiment,the method contains the steps of isolating exosomes from a urine sampleof the mammal and detecting said a HIV-associated biomarker from saidisolated exosomes.

In another related embodiment, the method further comprises the step ofdetermining the progress of HIV infection in said mammal based on thepresence or absence of said HIV-associated biomarker in the isolatedexosomes.

Another aspect of the present invention relates to a method formonitoring the progress of HIV-associated nephropathy in a mammal. Inone embodiment, the method contains the steps of isolating exosomes froma urine sample from the mammal and detecting said a HIV-associatedbiomarker from said isolated exosomes.

In another related embodiment, the method further comprises the step ofdetermining the progress of HIV-associated nephropathy in said mammalbased on the presence or absence of said HIV-associated biomarker in theisolated exosomes.

Another aspect of the present invention relates to a method formonitoring the effectiveness of treatment to a mammal with an anti-HIVagent. The method includes the steps of determining a HIV-associatedbiomarker profile in urine exosomes in the urine sample obtained from amammal prior to administration of an agent; determining a HIV-associatedbiomarker profile in urine exosomes in a one or more post-administrationurine samples of said mammal; comparing the HIV-associated biomarkerprofile in the pre-administration sample with the HIV-associatedbiomarker profile in the post administration sample or samples; anddetermining the effectiveness of the agent.

In a related embodiment, the method further contains the step ofaltering the administration of the agent to said mammal.

Another aspect of the present invention relates to a kit for detectingHIV infection or monitoring the progress of HIV infection in a mammal.The kit contains one or more reagents for preparing exosomes sample fordetection and at least one HIV-associated biomarker as a standard.

In another related embodiment, the exosomes are detected by Westernblot.

In another related embodiment, the kit further includes a label.

In another related embodiment, the kit further includes a label withinstruction.

Another aspect of the present invention relates to a kit for diagnosinga HIV-associated disease or monitoring the progress of a HIV-associateddisease in a mammal. The kit contains one or more reagents for preparingexosomes sample for detection and at least one HIV-associated biomarkeras a standard.

In another related embodiment, said HIV-associated disease isHIV-associated nephropathy.

In one related embodiment, the HIV-associated biomarker is selected fromthe group consisting of Nef, HIV envelope gp120, HIV protease, Vif,Gag-Pol, Gag, p24, Rev, reverse transcriptase (RT), Tat, p1, p17, Vpu,Vpr, gp41 and DNA polymerase.

In a further related embodiment, the HIV-associated biomarker is Nef,HIV protease, Vif, Pol, or Gag.

In a further related embodiment, the HIV-associated biomarker is Nef.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a flow chart showing an embodiment of a method for detectingHIV-infection or monitoring the progress of HIV-infection in a mammalusing a urine sample from the mammal.

FIGS. 2A-2C are composites of samples SELDI-TOF-MS spectrum of urinaryexosomes from patients in the HIVAN groups.

FIGS. 3A-3D are composites of samples SELDI-TOF-MS spectrum of urinaryexosomes from patients in the AA HIV+ groups.

FIGS. 4A-4C are composites of samples SELDI-TOF-MS spectrum of urinaryexosomes from patients in the HIV White groups.

FIGS. 5A-5E are composites of samples SELDI-TOF-MS spectrum of urinaryexosomes from patients in the FSGS groups.

FIGS. 6A-6C are composites of samples SELDI-TOF-MS spectrum of urinaryexosomes from patients in the Normal Controls groups.

FIGS. 7A-7E are composites of transmission electron microscope (TEM)pictures of urinary exosomes isolated from patients from the HIVAN group(FIG. A), the FSGS group (FIG. B), the African American (AA) HIV+ group(FIG. C), the white HIV+ group (FIG. D), and the normal control group(FIG. E).

FIG. 8 is a composite of pictures showing Western blot analysis ofurinary vesicles from HIV+ patients and controls. Vesicles were isolatedfrom urine by ultrafiltration and analyzed for the presence of HIV Nefor other HIV proteins. The top panel used anti-HIV Nef monoclonalantibodies, while the lower panel utilized pooled HIV+ patient sera sthe primary antibodies. Patients 27, 28, 30, 41 and 104 were AA.Patients 108, 103, 86 and 48 were HIV+ white patients. The last panel iscontrol panel for three HIV negative individuals, recombinant HIV Nefand p24.

DETAILED DESCRIPTION

The practice of the embodiments described in further detail below willemploy, unless other wise indicated, conventional methods ofdiagnostics, molecular biology, cell biology, biochemistry andimmunology within the skill of the art. Such techniques are explainedfully in the literature. All publications, patents and patentapplications cited herein, whether supra or infra, are herebyincorporated by reference in their entirety.

One aspect of the present invention relates to a method for detectingHIV infection in a mammal. As shown in FIG. 1, an embodiment of themethod 100 includes the steps of: isolating (110) exosomes from a urinesample of a mammal and detecting (120) the presence of an HIV-associatedbiomarker from the isolated exosomes.

In one embodiment, the method may further comprise the step ofdetermining (130) whether the mammal is infected with HIV based on thepresence or absence of HIV-associated biomarkers in the isolatedexosomes.

Exosomes are 50-90 nm vesicles secreted by a wide range of mammaliancell types. First discovered in maturing mammalian reticulocytes, theywere shown to be a mechanism for selective removal of many plasmamembrane proteins. An exosome is created intracellularly when a segmentof the cell membrane spontaneously invaginates and is endocytosed. Theinternalized segment is broken into smaller vesicles that aresubsequently expelled from the cell. The latter stage occurs when thelate endosome, containing many small vesicles, fuses with the cellmembrane, triggering the release of the vesicles from the cell. Thevesicles (once released are called exosomes) consist of a lipid raftembedded with ligands common to the original cell membrane.

Although the exosomal protein composition varies with the cell oforigin, most exosomes contain the soluble protein Hsc 70. Certain immunecells, such as dendritic cells and B cells, secrete exosomes that manyscientists believe play a functional role in mediating adaptive immuneresponses to pathogens and tumors. It has been reported that immaturedendritic cell-derived exosomes can mediate HIV trans infection (Wiley RD et al., Proc Natl Acad Sci U.S.A. 2006 Jan. 17; 103(3): 738-743).

The isolating step 110 can be accomplished by centrifugation orfiltration. In one embodiment, exosomes in a urine sample are sedimentedby centrifugation. The sedimented exosomes are washed and resuspended ata proper concentration for further analysis. In certain embodiments, theurine sample is centrifuged at 100,000×g or above for 10-120 minutes tosediment the exosomes. In one embodiment, the urine sample iscentrifuged at 100,000×g for 60-120 minutes to sediment the exosomes.

In certain other embodiments, the exosomes in the urine sample areprecipitated by a two-step centrifugation process that includes a low gforce centrifugation to remove calls and other large particles in theurine and a high g force centrifugation to precipitate the exosomes. Inone embodiment, the urine sample is first centrifuged at 5,000-25,000×gfor 5-30 minutes. The supernatant is then transferred to another tubeand is centrifuged again at 100,000×g or above for 30-120 minutes tosediment the exosomes. In a preferred embodiment, the urine sample isfirst centrifuged at 20,000-22,000×g for 10-20 minutes. The supernatantis then transferred to another tube and is centrifuged again at100,000×g for 30-90 minutes to sediment the exosomes. The sedimentedexosomes are then resuspended in a liquid medium for further analysis.

The liquid medium can be isotonic, hypotonic, or hypertonic. In certainembodiments, the liquid medium contains a buffer and/or at least onesalt or a combination of salts. Buffers can maintain pH within aparticular range, for example, between 1 and 12, and are also referredto as pH stabilizing agents. More typically, pH will range within aboutpH 5.0 to about pH 12.0. A particular example of a pH stabilizing agentis a zwitterion. Specific non-limiting examples of pH stabilizing agentsinclude Tris(hydroxymethyl)aminomethane hydrochloride (TRIS),N-(2-hydroxyethyl)piperazine-N′-2-ethanesulfonic acid (HEPES),3-(N-morpholino) propanesulfonic acid (MOPS), 2-(N-morpholino)ethanesulfonic acid (MES),N-tris[hydroxymethyl]methyl-2-aminoethanesulfonic acid (TES),N-[carboxymethyl]-2-aminoethanesulfonic acid (ACES),N-[2-acetamido]-2-iminodiacetic acid (ADA),N,N-bis[2-hydroxyethyl]-2-aminoethanesulfonic acid (BES),N-[2-hydroxyethyl]piperazine-N-[2-hydroxypropoanesulfonic acid](HEPPSO), N-tris[hydroxymethyl]methylglycine (TRICINE),N,N-bis[2-hydroxyethyl]glycine (BICINE),4-(cyclohexylamino)-1-butanesulfonic acid (CABS),3-(cyclohexylamino)-1-propanesulfonic acid (CAPS),3-(cyclohexylamino-2-hydroxy-1-propanesulfonic acid (CAPSO),2-(cyclohexylamino)ethanesulfonic acid (CHES),N-(2-hydroxyethyl)piperazine-N′-(3-propanesulfonic acid) (EPPS),piperazine-N,N′-bis(2-ethanesulfonic acid (PIPES),[(2-hydroxy-1,1-bis[hydroxymethyl]ethyl)amino]-1-propanesulfonic acid(TAPS), N-tris(hydroxymethyl)methyl-4-aminobutane sulfonic acid (TABS),2-amino-2-methyl-1-propanol (AMP),3-[(1,1-dimethyl-2-hydroxyethyl)amino]-2-hydroxypropanesulfonic acid(AMPSO), ethanolamine and 3-amino-1-propanesulfonic acid. Additionalspecific non-limiting examples of pH stabilizing agents includepotassium chloride, citric acid, potassium hydrogenphthalate, boricacid, potassium dihydrogenphosphate, diethanolamine, sodium citrate,sodium dihydrogenphosphate, sodium acetate, sodium carbonate, sodiumtetraborate, cacodylic acid, imidazole, 2-Amino-2-methyl-1-propanediol,tricine, Gly-Gly, bicine, and a phosphate buffer (e.g., sodium phosphateor sodium-potassium phosphate, among others).

Buffers or pH stabilizing agents are typically used in a range of about0.1 mM to about 500 mM, in a range of about 0.5 mM to about 100 mM, in arange of about 0.5 mM to about 50 mM, in a range of about 1 mM to about25 mM, or in a range of about 1 mM to about 10 mM. More particularly,buffers can have a concentration of about (i.e., within 10% of) 1 mM, 2mM, 5 mM, 10 mM, 15 mM, 20 mM, 25 mM, 30 mM, 40 mM, or 50 mM.

The liquid medium may further contain a chelating agent. Chelatingagents typically form multiple bonds with metal ions, and aremultidentate ligands that can sequester metals. Metal sequestration canin turn reduce or prevent microbial growth or degradation ofbiomolecules (e.g., peptide or nucleic acid), which in turn can improvepreservation of biomolecules absorbed to a substrate. Specificnon-limiting examples of chelating agents include EDTA(Ethylenediamine-tetraacetic acid), EGTA(Ethyleneglycol-O,O′-bis(2-aminoethyl)-N,N,N′,N′-tetraacetic acid),GEDTA (Glycoletherdiaminetetraacetic acid), HEDTA(N-(2-Hydroxyethypethylenediamine-N,N′,N′-triacetic acid), NTA(Nitrilotriacetic acid), Salicylic acid, Triethanolamine and porphines.Typical concentrations of chelating agents are in a range of about 0.1mM to about 100 mM, in a range of about 0.5 mM to about 50 mM, or in arange of about 1 mM to about 10 mM.

The liquid medium may also contain a denaturing agent. Denaturing agentsand detergents typically form a chemical bridge between hydrophobic andhydrophilic environments, which in turn disrupt or diminish thehydrophobic forces required to maintain native protein structure.Particular non-limiting chemical classes of denaturing agents anddetergents include anionic surfactants, nonionic surfactants, cationicsurfactants and ampholytic surfactants. Specific non-limiting examplesof detergents include guanidinium thiocyanate, SDS, Sodium laurylsulfate, NP40, triton X-100, Tween, Sodium cholate, Sodium deoxycholate,Benzethonium chloride, CTAB (Cetyltrimethylammonium bromide),Hexadecyltrimethylammonium bromide, and N,N-Dimethyldecylamine-N-oxide.

The liquid medium may further contain a denaturing agent. Reducingagents and antioxidants typically inhibit microbial growth and reducebiomolecule oxidation. Particular non-limiting classes of such agentsinclude free radical scavenging agents. Specific non-limiting examplesof reducing agents and anti-oxidants include DTT (dithiothreitol),dithioerythritol, urea, uric acid, 2-mercaptoethanol, dysteine, vitaminE, vitamin C, dithionite, thioglycolic acid and pyrosulfite.

The liquid medium may further contain a preservative or stabilizingagent. Preservatives or stabilizing agents can be used if it is desiredto inhibit or delay degradation of an HIV-associated biomarker. Specificnon-limiting examples of preservatives and stabilizing agents includesodium azide and polyethylene glycol (PEG). Typical concentrations ofpreservatives and stabilizing agents range from about 0.05% to about 1%.

The liquid medium may further contain a protease inhibitor. Proteaseinhibitors inhibit peptide degradation. Particular non-limiting classesof protease inhibitors include reversible or irreversible inhibitors ofsubstrate (e.g., peptide) binding to the protease. Particularnon-limiting classes of protease inhibitors include serine and cysteineprotease inhibitors. Specific non-limiting examples of proteaseinhibitors include PMSF, PMSF Plus, APMSF, antithrombin III, Amastatin,Antipain, aprotinin, Bestatin, Benzamidine, Chymostatin, calpaininhibitor I and II, E-64,3,4-dichloroisocoumarin, DFP, Elastatinal,Leupeptin, Pepstatin, 1,10-Phenanthroline, Phosphoramidon, TIMP-2, TLCK,TPCK, trypsin inhibitor (soybean or chicken egg white), hirustasin,alpha-2-macroglobulin, 4-(2-aminoethyl)-benzenesulfonyl fluoridehydrochloride (AEBSF) and Kunitz-type protease inhibitors.

In another embodiment, exosomes in a urine sample are collected bypassing the urine sample through a filter having a pore size that issmaller than the average size of exosomes. The exosomes are then removedfrom the filter and resuspended at a proper concentration for furtheranalysis. In certain embodiments, exosomes in the urine samples arecollected using centrifuge filters with a molecular weight cutoff of 500kd-50 kd. In one embodiment, exosomes in the urine samples are collectedusing centrifuge filters with a molecular weight cutoff of 100 kd.

The detecting step 120 can be performed using any technology that iscapable of identifying a HIV-associated biomarker. As used herein, theterm “HIV-associated biomarker” refers to proteins or fragments ofproteins that are associated with HIV infection, the progress of HIVinfection, and HIV-related diseases such as HIV-associated nephropathy.Examples of HIV-associated biomarker include, but a not limited to, HIVproteins such as HIV envelope gp120/gp41, HIV protease, Nef, Vif,Gag-Pol, Gag, p24, Rev, reverse transcriptase, Tat, p1, p17, Vpr, Vpuand DNA polymerase.

A number of technologies can be used to identify a HIV-associatedbiomarker. Examples of such technologies include, but are not limitedto, electrophoresis such as one-dimensional and two-dimensional gelanalysis, Western blot, ELISA, HPLC, FPLC, mass spectrometry, proteinsequencing, antibody array and combinations thereof. In one embodiment,the biomarkers are identified by Western blot. In another embodiment,the biomarkers are identified by Surface Enhanced LaserDesorption/Ionization Time of Flight Mass Spectrometry (SELDI-TOF-MS)and LC-MS/MS.

The determining step is carried out by comparing the HIV-associatedbiomarker profile in a urine sample to HIV-associated biomarker profilesstored in a database. A diagnosis is made based on the result of thecomparison. A HIV-associated biomarker profile may contain from zero tomultiple HIV-associated biomarkers. For example, the HIV-associatedbiomarker profile of a healthy mammal may contain no HIV-associatedbiomarkers. On the other hand, the HIV-associated biomarker profile of apatient with HIVAN may contain a plurality of HIV-associated biomarkers.

In one embodiment, the method 100 is used to monitor the progress of HIVinfection in the mammal. In this embodiment, pertinent information fromthe medical record of the mammal may also be used in the determiningstep 130 to make a diagnosis.

In another embodiment, the method 100 is used for diagnosingHIV-associated nephropathy in a mammal. In this embodiment, the geneticbackground and pertinent information from the medical record of themammal may also be used in the determining step 130 to make a diagnosis.In another embodiment, the method 100 may also be used to monitor theprogress of HIV-associated nephropathy in the mammal.

In another embodiment, the method 100 is used to monitor effects duringclinical trials of HIV-treatment. In such clinical trials, theHIV-associated biomarker profile in urine exosomes can be used as areadout, indicative of the physiological response of a mammal to thetreatment.

In one related embodiment, a mammal is a human, monkey, gorilla orbaboon.

In a preferred related embodiment, the mammal is a human.

Another aspect of the present invention provides a method for monitoringthe effectiveness of treatment of a mammal with an anti-HIV agent. Inone embodiment, the method includes the steps of: detecting theHIV-associated biomarker profile in urine exosomes in the sampleobtained from a mammal prior to administration of the agent; detectingthe HIV-associated biomarker profile in urine exosomes in one or morepost-administration samples obtained from the mammal; comparing theHIV-associated biomarker profile in the pre-administration sample withthe HIV-associated biomarker profile in the post administration sampleor samples.

In another embodiment, the method further comprises the step ofdetermining the effectiveness of the agent and optionally altering theadministration of the agent to the mammal. According to such anembodiment, the HIV-associated biomarker profile may be used as anindicator of the effectiveness of an agent, even in the absence of anobservable phenotypic response.

Another aspect of the present invention relates to a kit for detectingHIV infection or monitoring the progress of HIV infection in a mammal.The kit contains one or more reagents for preparing exosomes sample fordetection and at least one HIV-associated biomarker as a standard.

In another related embodiment, the exosomes are detected by Westernblot.

Another aspect of the present invention relates to a kit for diagnosinga HIV-associated disease or monitoring the progress of a HIV-associateddisease in a mammal. The kit contains one or more reagents for preparingexosomes sample for detection and at least one HIV-associated biomarkeras a standard.

In another related embodiment, the HIV-associated disease isHIV-associated nephropathy.

In another related embodiment, the HIV-associated biomarker is selectedfrom the group consisting of Net HIV envelope gp120, HIV protease, Vif,Gag-Pol, Gag, p24, Rev, reverse transcriptase (RT), Tat, p1, p17, Vpu,Vpr, gp41 and DNA polymerase.

The kits described above typically include a label or packaging insertincluding a description of the components or instructions for use.Exemplary instructions include, instructions for collecting a urinesample, for harvesting exosomes from the urine, and for detecting anHIV-associated biomarker. The kits described above may additionallyinclude a liquid suitable for resuspending the exosomes isolated fromthe urine sample. The kits described above may contain a container forcollecting a urine sample and/or a centrifuge filter for isolatingexosomes from the urine sample.

The present invention is further illustrated by the following exampleswhich should not be construed as limiting. The contents of allreferences, patents and published patent applications cited throughoutthis application, as well as the Figures and Tables, are incorporatedherein by reference.

EXAMPLE 1 Materials and Methods

Patients

HIV+ patients, at various stages of disease, were recruited for thisstudy from four clinical sites in the Atlanta metropolitan area. Onlythose patients on dialysis were excluded from this study. All sampleswere collected in accordance with protocols approved by theInstitutional Review Board and the Human Subjects Research Committee atMorehouse School of Medicine, and informed consent was obtained from allpatients and healthy volunteers according to the guidelines institutedby the Institutional Review Board. Patients were divided into fivegroups: African American patients with HIV (AA HIV+), white patientswith HIV (White HIV+), patients with HIVAN (HIVAN), African Americanpatients with no HIV but FSGS, and healthy controls. Pertinentinformation was also collected from the medical record of the patients.

Sample Collection and Storage

Urine samples were collected from patients during routine clinicalvisits. Clinical data were obtained from the medical record of thepatients. Urine was collected in sterile containers and transported backto the laboratory. Urinalysis was performed on each specimen using aMultistix 10 SG Reagent Strip (Bayer Corporation, Elkhart, Ind.) and thealbumin to creatine ratio determined by a Siemens Clinitek Microalbumindipstick (Bayer Corp.). The strips were read on a Siemens ClinitekStatus instrument (Bayer Corp.). Samples were centrifuged at2,000.times.g for 10 minutes to remove whole cells and sediment. Theremaining urine samples were aliquoted into 4 ml volumes and stored at−80.degree.C. until they were analyzed.

Isolation of Exosomes

Two methods were evaluated for the isolation of exosomes, either highspeed ultracentrifugation or ultrafiltration using a molecular weightcutoff filter. For the ultracentrifugation method, 4 ml of urine weretransferred into a polycarbonate centrifuge tube and centrifuged at21,000.times.g for 15 minutes. The supernatant was removed and againcentrifuged at 100,000.times.g for 60 minutes to sediment the exosomes.The excess urine was decanted and the pellet was reconstituted in100.mu.l phosphate buffered saline (PBS) and stored at 4.degree.C. Forthe ultrafiltration method, 4 ml of urine were added to an Amicon Ultracentrifugal filter device (Ultracel, 100 k cutoff, Millipore, Inc.) andcentrifuged at 4,000.times.g for 20 min in a swinging bucket rotor. Onehundred .mu.l of PBS was used to rinse the filter and dilute theretentate. The protein concentration was determined using thebicinchoninic acid protein assay (Pierce).

Surface Enhanced Laser Desorption/Ionization Time of Flight MassSpectrometry

Normal phase chips (ProteinChip NP20; Ciphergen Biosystems, Fremont,Calif.), that bind proteins through hydrophilic and charged residueswere used for the analysis. Five .mu.l of vesicle preparation wasapplied in duplicate to the chip and incubated for 30 minutes in a humidchamber. Chips were washed three times with 5.mu.l high-performanceliquid chromatography (HPLC)-grade water and air dried for 10 minutes.Saturated sinapinic acid (SPA, Ciphergen Biosystems, CA) were preparedin 50% acetonitrile/0.5% trifluoroacetic acid according to manufacturersinstructions. One .mu.l of matrix solution (SPA) to each spot andair-dried and subsequently read with the ProteinChip Reader II,(Ciphergen Biosystems) using the following settings: laser intensity250; detector sensitivity 10; high mass 300 Kda, optimized from 3 Kda to50 Kda. The data acquisition method was set to automatic laseradjustment and peaks were auto identified from 3 Kda and 50 Kda.

LC-MS/MS

Collected exosomes were analyzed by LC/MS using an LTQ mass spectrometer(ThermoFinnigan). The pelleted exosomes were first extracted with 2 Dgel loading buffer (Q-biosciences) made fresh the day of analysis. Thesolubilized pellet was then precipitated using four volumes of ice-cold(−20° C.) acetone and incubated overnight at −20° C. The precipitate wascollected by centrifugation at 19,200×g. The pellet was dried andre-dissolved into 50 mM ammonium bicarbonate (AmBIC). The proteinsolution was first reduced using 2 μl of a 500 mM stock of DTT (Qbiosciences, single use) at 56° C. for 30 minutes. The solution was thenalkylated by adding 2 μl of a 1M stock of iodacetic acid (IAA;Q-biosciences, single use) and incubating at room temperature for 30minutes in the dark. A fresh vial of trypsin (Promega Gold mass specgrade) was diluted 8 μl to 312 μl in 50 mM AmBic and kept on ice. Tenmicroliters of the diluted trypsin was then added to the reaction and itwas incubated at 37° C. for 4 hours with shaking. Then 50 μl of 0.5%formic acid was added and the mixture was either directly analyzed orstored at −20° C. for analysis. Ten microliters of sample was injectedusing an automated sampler onto a captrap (Michrom) C18 peptide trap ata flow of 10 μl per min. After 10 min the flow was switched to a 0.5mm×50 micron C18 column (Microm). Peptides were eluted using a lineargradient of 5-40% acetonitrile in water over 50 min. The eluted peptideswere directly introduced into an LTQ mass spectrometer using microsprayionization (Michrom Advance) at a flow rate of approximately 3 μl permin. Samples were analyzed using Excalibur 2.2 software set to analyzeions in a data dependent scanning mode. A precursor scan was followed bydata dependent scans of the three most intense ions. Files were searchedagainst a subset of the NR database that included Human and HIV proteinsusing BioWorks 3.1 (ThermoFinnigan). The threshold for DTA generationwas set at 200 and the tolerance for peptides was set at 0.5 Da andproteins at 1.0 Da. Initial protein identification lists were generatedusing consensus scores of >10.0 and Xcorr scores >1.0.

Electrophoresis and Western Blot

SDS PAGE electrophoresis. Samples were heated at 85° C. for 2 minutes ina Tris-Glycine SDS sample reducing buffer and loaded in a 4-12%Criterion XT Bis-Tris precast acrylamide gel (BioRad, Hercules, Calif.).Approximate 200 ng of sample ere loaded into each well. Controlsconsisted of recombinant HIV Nef (gift of Dr. Andrea Raymond) and HIVrecombinant p24 (Immunodiagnostics, Inc.) that were loaded at 30 to 40ng per well. The gels were stained using Gel Code Blue (Pierce, Inc.) orthe proteins were transferred to PVDF membrane (Immobilon-P, MilliporeCorp, Billerica, Mass.) for western blot analysis. The SNAP ID system(Millipore, Corp) was used for the western blot analysis for thepresence of either HIV Nef or HIV proteins. HIV Nef identification wasperformed using a monoclonal mouse anti-HIV Nef monoclonal antibody(1:1500, Chemicon Int., CA) and a secondary antibody, goat anti-mouseIgG (H+L) peroxidase conjugated antibody (1:15,000, JacksonImmunoresearch, West Grove, Pa.). HIV proteins were detected usingpooled human HIV+ serum (1:15,000) as the primary antibody and a goatanti-human IgG (H+L) peroxidase conjugated antibody (1:15,000, JacksonImmunoresearch). The membrane was incubated with a chemiluminescentsubstrate (SuperSignal West Femto Maximum, Pierce, Inc.) and exposed toX-ray film (CL-Xposure, Kodak) and developed.

Transmission Electron Microscopy

Samples were fixed in 2.5% glutaraldehyde in 0.1M cacodylate buffer for2 hours at 4 C followed by 2 washes with 0.1M cacodylate buffer, 5minutes each. The samples were fixed again with 1% osmium tetroxide in0.1M cacodylate buffer for 1 hour at 4° C. followed by 2 washes with thecacodylate buffer and 3 washes with deionized water, 5 minutes each.Thin sections were cut, stained with 0.5% aqueous uranyl acetate for 2hours at room temperature, and viewed with a JEOL 1200EX transmissionelectron microscope.

EXAMPLE 2 Isolation of Urinary Vesicles, Ultracentrifugation VersusUltrafiltration

Vesicles from the urine of six (6) different HIV+ patients were isolatedby ultracentrifugation or ultrafiltration to determine which of the twomethods yielded the greatest amount of protein. The ultrafiltrationmethod consistently isolated more protein, 2930 μg (median), than theultracentrifugation method, 591 μg (median).

EXAMPLE 3 SELDI-TOF-MS Spectrum of Urinary Exosomes from Patients

Urinary exosomes from patients of various groups are analyzed bySELDI-TOF-MS. The results are confirmed by LC-MS/MS. Spectrum ofSELDI-TOF-MS from representative patients is shown in FIGS. 2-6. Table 1summarizes proteins that were detected by SELDI-MS and confirmed byLC-MS/MS in different test groups.

TABLE 1 Proteins detected in urine samples by SELDI-MS Patient MWProtein HIVAN 10,585 HIV envelope gp; HIV Protease 23,546 HIV envelopegp; HIV Nef; HIV Vif 33,464 HIV protein gp; mu A03009B12Rik Protein45,632 HIV envelope gp; HIV pol protein 66,587 HIV envelope gp; HIV Nef;PgD synthase 78,942 Unknown AA HIV 23,684 HIV envelope gp; HIV Nef; PgDsynthase 83,256 Unknown FSGS 66,533 Unknown White HIV 23,935

Table 2 summarizes the urine protein profiles in individual patient.

TABLE 2 Urine protein profiles in individual patient ID Diagnosis RaceCD4 VL Nef Gag Pol Protease Rev RT Tat Vif pl p24 P17 poly 22 HIVAN AA XX X X X X X X X X 27 HIV/AIDS AA 134 <50 X 28 HIV/AIDS AA 134 19,800 X XX X 30 HIV/AIDS AA <20 <10,000 X X X X X X X X X X 41 HIV AA 440 29,187X X X 46 HIV AA 689 <50 X X X X X 62 HIV AA 232 <50 X 63 HIV/AIDS AA 832,023 X 70 HIV AA 990 <50 X 104 HIV AA 313 77 X X 111 HIV/AIDS AA 182<50 X X 112 HIV AA 584 <200 X X 48 HIV W 454 52000 X X X X 86 HIV W 1642<75 X X X X 103 HIV W 560 150 X X X 106 HIV W 302 <50 108 HIV W 653 <50X X X 110 HIV W 379 <50 X XTransmission Electron Microscopy (TEM)

TEM was used to visualize the patients' vesicles from urine. Exosomeswere isolated from 4 ml of urine, fixed and embedded for TEM. The figureshows distribution of vesicles in: A) HIVAN; B) focal segmentalglomerusclerosis; C) AA HIV+; and D) white HIV+; E) AA HIV negative.HIVAN, FSGS and AA HIV+ patients clearly have a higher population ofvesicles compared to white HIV+ patients and AA normal patients.

Ingenuity Pathways Analysis

As shown in Examples 1 and 2, the SELDI-TOF-MS peaks of AA HIV+ patientsexhibited exceedingly similar protein patterns of those of HIVANpatients and slightly similar patterns to FSGS patients, suggesting thatthe AA HIV+ patients whose peaks were similar to those of HIVAN may bepredisposed to developing HIVAN. The baseline protein value (30-2000mg/dl) for the FSGS patients and AA HIV+ patients was in the same range.Similar to the protein values for HIVANb, but unlike FSGS patients, theproteins detected in AA HIV+ patients were analogous to those of HIVANpatients. This underscores the significance that HIV infection, with orwithout the presence of renal disease, is still largely responsible fordevelopment of HIVAN; and a prior condition of renal insufficiencybefore HIV infection is not a necessary prerequisite for the developmentof HIVAN.

Unlike AA HIV+ patients, protein profiles of white HIV+ patients were astark contrast to the protein profiles of HIVAN patients. It suggeststhat factors other than simple infection of renal cells or theinfiltration of infected immune cells in renal tissue probably mediatethe expression of nephropathy. The number of AA HIV+ and HIVAN (12/15)patients that had detectable Nef using LC-MS/MS piggybacks on theearlier assertion about the similarities between the kidney pathologiesof transgenic mice expressing Nef and HIVAN patients, hinting that Nefmay be involved in causing kidney damage to HIV patients. This mayexplicate the relationship, if any, between the similarity in the kidneypathology of transgenic mice expressing Nef and HIVAN patients, and thesimilarity between the expression of Nef in the protein profiles of AAHIV+ and HIVAN patients. It may also shed additional insight as to whatrole Nef plays in the pathogenesis of HIVAN. HIV envelope gp was alsodetected by LC-MS/MS in HIVAN and AA HIV+ patients. Although local HIVinfection of the kidney may have implications beyond development ofHIVAN, with kidney serving as a potential viral reservoir, a corollarywould be that some of these viruses in the reservoir would find their ayin the urine.

The transmission electron microscopy (FIG. 7) shown in the urine of AAHIV+, FSGS and HIVAN patients' conspicuous vesicles were not evident inthe urine of white HIV+ and AA normal patients. The HIVAN exosomesolution was diluted 10 fold because the initial visualization expressedan exceedingly dense population of exosomes that was difficult tovisualize, suggesting that HIVAN patients may be producing vesicles atan increasing rate than all the other patient groups. The HIV-associatedkidney damage may responsible for this marked increase in exosomeexcretion in AA HIV+ and HIVAN patients.

EXAMPLE 4 Western Blot Analysis, Validation of the Presence of HIV NEFand Other HIV Proteins

Urinary vesicle samples from fourteen (14) HIV+ AA and nine (9) HIV+white patients were isolated using ultrafiltration and analyzed for thepresence of HIV Nef and other HIV proteins using western blot analysis.All the HIV+ AA samples were positive for HIV Nef by western blot,although HIV Nef was not detected in sample 41 by mass spectrometry(FIG. 8). This discrepancy could be caused by the isolation methodutilized for the mass spectrometry analysis, which wasultracentrifugation, and yields less protein. HIV Nef was onlyidentified in four (4) HIV+ white patients while mass spectrometryidentified three (3) samples without HIV Nef. All HIV+ patients haddetectable HIV proteins by western blots, but had varying kinds andamounts (FIG. 8).

The above description is for the purpose of teaching the person ofordinary skill in the art how to practice the present invention, and itis not intended to detail all those obvious modifications and variationsof it which will become apparent to the skilled worker upon reading thedescription. It is intended, however, that all such obviousmodifications and variations be included within the scope of the presentinvention, which is defined by the following claims. The embodiments areintended to cover the components and steps in any sequence which iseffective to meet the objectives there intended, unless the contextspecifically indicates the contrary.

What is claimed is:
 1. A method for monitoring the effectiveness oftreatment to a human subject with an anti-HIV agent, comprising:detecting a HIV-associated biomarker profile consisting ofHIV-associated proteins in urine exosomes in one or more urine samplesobtained from a human subject prior to administration of said anti-HIVagent; detecting a HIV-associated biomarker profile consisting ofHIV-associated proteins in urine exosomes in one or morepost-administration urine samples of said human subject; comparing theHIV-associated biomarker profile in the pre-administration sample orsamples with the HIV-associated biomarker profile in the postadministration sample or samples; and determining the effectiveness ofsaid anti-HIV agent, wherein a reduction in level of HIV-associatedproteins indicates effectiveness of treatment, and wherein saidHIV-associated biomarker profile consists of one or more HIV-associatedproteins selected from the group consisting of Nef, HIV envelope gp120,HIV protease, Vif, Gag-Pol, Gag, Rev, reverse transcriptase (RT), Tat,p1, p17, Vpu, Vpr, gp41and DNA polymerase.
 2. The method of claim 1,further comprising: altering the dose or route of administration of saidanti-HIV agent to said human subject.
 3. The method of claim 1, whereinsaid HIV-associated biomarker profile comprises Nef, HIV protease, Vif,Gag-Pol, or Gag.
 4. The method of claim 1, wherein said HIV-associatedbiomarker profile comprises Nef.
 5. The method of claim 1, wherein saidurine exosomes are isolated by centrifugation.
 6. The method of claim 1,wherein said urine exosomes are isolated by filtration.
 7. The method ofclaim 1, wherein said HIV-associated biomarker profile is determined byone or more techniques selected from the group consisting ofelectrophoresis, ELISA, Western blot, HPLC, FPLC, mass spectrometry(MS), antibody array and protein sequencing.
 8. The method of claim 7,wherein said HIV-associated biomarker profile is determined bySELDI-TOF-MS or LC-MS/MS.
 9. The method of claim 7, wherein saidHIV-associated biomarker profile is determined by ELISA or Western blot.10. The method of claim 7, wherein sid HIV-associated biomarker profileis determined by electrophoresis is a one-dimensional gel analysis ortwo-dimensional gel analysis.
 11. The method of claim 1, wherein saidurine exosomes are 50-90 nm vesicles.
 12. The method of claim 1, whereinsaid HIV-associated biomarker profile comprises Nef, Gag and Pol.